Some standard content:
ICS13.100
National Occupational Health Standard of the People's Republic of China GBZ25—2002
Pathologic Diagnostic Criteria of Pneumoconioses2002-04-08 Issued
2002-06-01 Implementation
Ministry of Health of the People's Republic of China
The entire contents of this standard are mandatory. Foreword
This standard is formulated in accordance with the "Law of the People's Republic of China on the Prevention and Control of Occupational Diseases". From the date of implementation of this standard, if there is any inconsistency between the original standard GB7883-1988 and this standard, this standard shall prevail. In the diagnosis of pneumoconiosis, it is often necessary to examine and diagnose gross specimens or household examination specimens. There must be standardized working procedures and unified diagnostic standards. Therefore, this standard is formulated. Appendix A of this standard is an informative appendix, and Appendix B, C, D, and E are normative appendices. This standard is proposed and managed by the Ministry of Health of the People's Republic of China. This standard was drafted by the Institute of Occupational Health and Poison Control of the Chinese Center for Disease Control and Prevention and the School of Public Health of West China University of Medical Sciences. The participating units include the Anshan Iron and Steel Labor Hygiene Research Institute, Jiangxi Provincial Labor Hygiene and Occupational Disease Prevention and Control Institute, and Shanghai Occupational Disease Prevention and Control Institute.
This standard is interpreted by the Ministry of Health of the People's Republic of China. Pathological Diagnosis Standard for Pneumoconiosis
Pneumoconiosis refers to a disease characterized by pulmonary tissue fibrosis caused by inhalation of dust during production activities. 1 Scope
This standard specifies the pathological diagnosis standard for pneumoconiosis. This standard applies to the pathological diagnosis of pneumoconiosis. 2 Diagnostic Principles
GBZ25-2002
The pathological diagnosis of pneumoconiosis can only be made based on the pathological examination results obtained based on a detailed and reliable occupational history and standardized examination methods. The patient's previous chest X-rays, case summaries or death records and on-site labor hygiene data are essential reference conditions for diagnosis. 3 Diagnosis and staging standards
3.1 No pneumoconiosis
Only dust reactions are seen in the lungs and lymph nodes in the pulmonary drainage area; or pneumoconiosis lesions are seen in the lungs and lymph nodes in the pulmonary drainage area, and their scope and severity are not enough to be diagnosed as stage I pneumoconiosis. 3.2 Stage I pneumoconiosis
The total number of pneumoconiosis nodules observed visually and microscopically in all sections of the whole lung is more than 20; or more than 10, accompanied by diffuse pulmonary fibrosis close to grade 1/1a);
Pneumoconiosis diffuse pulmonary fibrosis grade 1/1 degree or above; the area of pneumoconiosis-emphysema in the whole lung accounts for more than 50%. 3.3 Stage II pneumoconiosis
The total number of pneumoconiosis nodules observed visually and microscopically in all lung sections is more than 50: or more than 20, accompanied by diffuse pulmonary fibrosis of grade 1/1 degree or above a)
b) Pneumoconiosis diffuse pulmonary fibrosis of grade 2/2 degree or above: c) The area of dust spots-emphysema in the whole lung accounts for more than 75%. 3.4 Stage III pneumoconiosis
a) Pneumoconiosis block fibrosis appears in the lungs, accompanied by pneumoconiosis lesions of stage I or above; b) Pneumoconiosis diffuse pulmonary fibrosis of grade 3/3 degree or above. The lesions that meet the above stages a, b or c can be diagnosed by stage. For instructions on the correct use of this standard
, see Appendix A (Informative Appendix), Appendix B, C, D, E (Normative Appendix). Appendix A
(Informative Appendix)
Instructions for the correct use of this standard
A.1 This standard is only applicable to the diagnosis of inorganic pneumoconiosis as specified by the state, and is not applicable to the diagnosis of lung diseases caused by organic dust: it is only applicable to autopsy and surgical lobectomy specimens, and is not applicable to the pneumoconiosis pathological diagnosis of small lung tissue biopsy, lung drainage lymph node biopsy, lung puncture, lung lavage fluid and other specimens. A.2 According to Article 7 of Chapter 2 of the Ministry of Health of the People's Republic of China (84) Weifangzi No. 16, pathological professionals have the right to diagnose pneumoconiosis pathology.
A.3 Pathological professionals with the right to diagnose should immediately conduct an examination and submit a diagnosis report after the "Pneumoconiosis Pathology Examination Application Form" and the information provided by the inspection unit are complete. The content of the pneumoconiosis pathology diagnosis report includes the name of the pneumoconiosis, stage, pathological type and complications.
The pneumoconiosis pathology diagnosis report is in duplicate, one copy is archived, and the other copy is submitted to the pneumoconiosis diagnosis group of the same level of the inspection unit for processing. The pathological diagnosis of pneumoconiosis can be used as the basis for the treatment of occupational diseases. B.1 Name of pneumoconiosis
Name according to the name of pneumoconiosis stipulated by the state.
B.2 Pathological types of pneumoconiosis
Appendix B
(Normative Appendix)
Notes on pneumoconiosis pathological standards
B.2.1 Nodular pneumoconiosis lesions are mainly characterized by pneumoconiosis collagen fiber nodules, accompanied by other pneumoconiosis lesions. B.2.2 Diffuse fibrosis pneumoconiosis lesions are mainly characterized by pneumoconiosis diffuse collagen fiber hyperplasia, accompanied by other pneumoconiosis lesions. B.2.3 Pneumoconiosis lesions are mainly characterized by pneumoconiosis with perifocal emphysema changes, and other pneumoconiosis lesions. B.3 Pneumoconiosis lesions
B.3.1 Visual observation of pneumoconiosis nodules: The lesions are quasi-round, with clear boundaries, gray-black color, and feel solid to the touch. Microscopic examination: It may be a silicic nodule, i.e. a dust lesion with a collagen fiber core; or a mixed dust nodule, i.e. a lesion in which collagen fibers and dust are intermixed but the collagen fiber component accounts for more than 50%; or a silicotuberculous nodule, i.e. a nodule formed by a mixture of silicic nodules or mixed dust nodules and tuberculous lesions.
B.3.2 Dust-induced diffuse fibrosis Diffuse collagen fiber hyperplasia caused by dust deposition around respiratory bronchioles, alveoli, interlobular septa, small bronchi and small blood vessels, and subpleural areas. B.3.3 Dust spots Visual observation: The lesions are dark, soft, with unclear boundaries, and are accompanied by enlarged air cavities with a diameter of more than 1.5 mm (perifocal emphysema) around the lesions. Microscopic examination: Reticulum fibers, collagen fibers and dust are intermixed in the lesions, and the collagen fiber component is less than 50%. The lesions are connected to the fibrotic lung interstitium in a star-shaped shape, accompanied by perifocal emphysema. B.3.4 Dust-like massive fibrosis Visual observation: The lesion is a gray-black or black, tough fibrous mass larger than 2×2×2 cm. Microscopic examination: It may be a fusion of pneumoconiosis nodules, a large area of dust-like collagen fibrosis, or a mixture of various pneumoconiosis lesions. B.3.5 Dust reaction refers to dust deposition in the lungs, pleura, and lymph nodes in the lung drainage area, macrophage reaction, and slight fibrous tissue hyperplasia.
B.4 Determination of the scope and severity of pneumoconiosis B.4.1 Nodule counting
a) Nodule diameter less than 2mm is counted as 0.5 (based on microscopic counting); b) Nodule diameter greater than 2mm is counted as 1 (visual counting and microscopic determination); c) Nodule diameter greater than 5mm is counted as 2 (visual counting and microscopic determination); d) Nodule diameter greater than 10mm is counted as 3 (visual counting and microscopic determination) B.4.2 Determination of pneumoconiosis diffuse fibrosis (grade/degree) a) Grade 1 disease Grade 1 fibrosis accounts for more than 25% of the total lung area; b) Grade 2 lesions account for more than 50% of the total lung area; c) Grade 3 lesions account for more than 75% of the total lung area; d) Grade 1 fibrosis is limited to the pulmonary lobule, or the pulmonary lobule septum, small bronchi and small blood vessels. Dust-like fibrosis e) Grade 2 is based on Grade 1, and the fibrosis is interconnected to form a grid or patchy shape, which may be accompanied by localized honeycomb changes; ) Grade 3 fibrosis destroys most of the lung tissue or forms fibrous masses: g) The severity of the lesion is determined by the average degree of 20 sections. If the degree is heavier than the grade, the grade shall be used as the standard. When diagnosing asbestosis, asbestosis bodies must be found. When the total area of pleural plaques complicated by asbestosis exceeds 200 cm2, the pneumoconiosis lesions are close to stage I or between stages I and II, and can be diagnosed as stage I or stage II. B.4.3 Dust plaque measurement
Mild dust plaque area accounts for more than 25% of the total lung area. Moderate dust spots account for more than 50% of the total lung area. Severe dust spots account for more than 75% of the total lung area. The area of pneumoconiosis is determined by visual observation of all sections of the whole lung, and dust spots on the pleural surface are not included. B.5 Complications of pneumoconiosis
The following diseases are listed as complications of pneumoconiosis pathological diagnosis. B.5.1 Pulmonary tuberculosis includes active pulmonary tuberculosis, namely caseous necrosis, caseous pneumonia, cavitary tuberculosis, miliary tuberculosis, endobronchial tuberculosis, hilar lymph node tuberculosis and exudative tuberculous pleurisy. To diagnose stage II silicosis tuberculosis, the basis of pneumoconiosis lesions above stage 2 must be present, and fibrous masses formed by pneumoconiosis tuberculosis lesions must be present. B.5.2 Nonspecific lung infections focus on bacterial, viral and fungal bronchitis, pneumonia and lung abscess, bronchiectasis, etc. When it is difficult to distinguish between fibrosis caused by inflammation and fibrosis caused by dust, it can be diagnosed and staged as dust-induced diffuse fibrosis.
B.5.3 Cor pulmonale, non-dust emphysema, pneumothorax. B.5.4 Lung cancer, malignant pleural mesothelioma.
C.1 Fixation of lung specimenswwW.bzxz.Net
Appendix C
(Normative Appendix)
Examination method of pneumoconiosis specimens
Dissection of the body should be performed within 24 hours after death. If refrigerated, its storage period can be appropriately extended. Remove the lungs, heart and mediastinum according to the usual inspection method, and immediately perfuse 10% formalin solution into the lungs through the trachea to make the lungs expand and fix properly under the physiological deep inspiration state. Before perfusion, gently press each lobe of both lungs to expel the gas in the lungs and clear the secretions in the trachea to facilitate the entry of the fixative into the lungs. During perfusion, the formalin column is about 40cm high and drips slowly. The perfusion volume varies depending on the lung capacity, generally 1000~1500ml, and the position of the liquid outflow outlet should be moved at any time so that all five lobes of the lungs can be properly expanded. At the same time, the lungs should be placed in a wide container filled with 10% formalin, and the surface of the lungs should be covered with a double layer of wet gauze to prevent air drying. After all five lobes of the lung are inflated, the trachea is ligated so that each lobe of the lung can stretch freely in the anatomical position. After five days of fixation, the specimen is cut open for examination according to regulations.
2 Visual inspection
The fixed lung specimen is placed on the lung cutting board, with the back of the lung close to the board surface. The lung is fixed on the board with the left hand, and the force is applied evenly to make the lung stick to the board surface as much as possible. Use a long knife to cut the lung into continuous coronal sections with a thickness of 1 cm each. The section at the tracheal carina is defined as the 0-position section, and the lung is cut into multiple sections towards the ventral (anterior) side and the dorsal (posterior) side, and the sequence is numbered as anterior 3, anterior 2, anterior 1, 0, posterior 1, posterior 2, posterior 3, etc. Observe the pneumoconiosis lesions of each section, such as dust spots, perifocal emphysema, nodules, diffuse fibrosis, massive fibrosis, lymph nodes and pleural lesions, and record them on the specified recording paper. Whole lung large section specimens can provide useful information for pneumoconiosis pathological diagnosis and staging, pathological X-ray comparative analysis, preservation of pneumoconiosis pathological archives and scientific research. It is recommended that units with conditions conduct routine examinations. C.3 Histological sampling
Ten pieces of tissue should be sampled from each lung, including all lobes. Each piece is 3-4mm thick and about 2cmx2cm in area. The tissue blocks should include various pneumoconiosis lesions and suspected pneumoconiosis lesions, including deep lung tissue and pleura. The number of tissue blocks should be consistent with the number of the record sheet. There is no limit to the number of lymph nodes sampled. The number of tissue blocks sampled for the diagnosis of complications is not within the prescribed 20 pieces.
Histological sections are routinely paraffin sections and hematoxylin and eosin stained. When necessary, staining of reticular fibers, collagen fibers, elastic fibers, tuberculosis bacteria, calcium, iron, etc. can be performed to identify the nature of the lesions. C.4 Analysis of dust in the lungs
Dust analysis is performed according to the microscopic ashing method.
Appendix D
(Normative Appendix)
Application form, record form, report form
D.1 The application form for pneumoconiosis pathology examination, the three record forms and the report form formats are unified nationwide. Anyone who applies for pneumoconiosis pathology examination must fill in the application form specified in this standard item by item, and the unit submitting the examination shall contact the pneumoconiosis pathology diagnosis unit. The diagnosis unit must complete the diagnosis work according to the format and requirements of the record form and report form. 2 Application form for pneumoconiosis pathology examination
D.3 Pneumoconiosis pathology examination record form
a: pneumoconiosis specimen visual observation record form;
b. Pneumoconiosis visual lesion reproduction diagram;
c: Pneumoconiosis specimen microscopic examination record form.
4 Pneumoconiosis pathology diagnosis report form
Appendix E
Standard photos for pneumoconiosis pathology diagnosis
(Normative Appendix)
Standard photos for pneumoconiosis pathology diagnosis, a set of 40 photos. The photo shows typical pneumoconiosis lesions and serves as an auxiliary explanation of the standard provisions for the pathological diagnosis of pneumoconiosis.
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